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Medicina
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Female Stress Urinary Incontinence Treatment: Do We Know Enough?
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Female Stress Urinary Incontinence Treatment: Do We Know Enough?

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 9302

Special Issue Editors

Dr. Mislav Mikuš

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Guest Editor
Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Petrova 13, 10 000 Zagreb, Croatia
Interests: minimally invasive surgery; endometriosis; adenomyosis
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Držislav Kalafatić

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Guest Editor
1. School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
2. Department of Obstetrics and Gynecology, University Hospital Center, 10000 Zagreb, Croatia
Interests: fetal growth retardation; cancer biology; evidence-based medicine; evidence-based practice; clinical trials

Special Issue Information

Dear Colleagues,

Urinary incontinence (UI) is a common condition that affects the quality of life (QoL) of women at different stages of life. To date, about 50% of UI cases are due to stress urinary incontinence (SUI). This problem is increasingly occurring in women of childbearing age and affects not only their sexual function but also their QoL and mental health. Despite advances in minimally invasive surgical techniques, conservative methods remain the first choice for SUI treatment. Although surgical treatments show excellent results in correcting the clinical presentation of SUI and improving QoL, more than 60% of patients refuse to undergo surgery, and nearly 15% of patients require reoperation due to the disease recurrence.

This Special Issue aims to focus on original clinical research, as well as narrative and systematic reviews in order to improve our knowledge about available therapeutic options of this common condition.

Dr. Mislav Mikuš
Prof. Dr. Držislav Kalafatić
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stress urinary incontinence
  • Kegel exercise
  • extracorporeal magnetic stimulation
  • bulking agents
  • minimally invasive surgery
  • mid-urethral sling

Published Papers (5 papers)

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Research

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13 pages, 5417 KiB  
Article
A Qualitative and Quantitative Study to Evaluate the Effectiveness and Safety of Magnetic Stimulation in Women with Urinary Incontinence Symptoms and Pelvic Floor Disorders
by Maurizio Filippini, Nicoletta Biordi, Antonella Curcio, Alessandra Comito, Beatrice Marina Pennati and Miriam Farinelli
Medicina 2023, 59(5), 879; https://doi.org/10.3390/medicina59050879 - 03 May 2023
Cited by 2 | Viewed by 1982
Abstract
Background and objectives: Involuntary loss of urine owed to dysfunction of the detrusor muscle or muscles of the pelvic floor is known as urinary incontinence (UI). In this study, ultrasound monitoring was employed for the first time to measure the usefulness and [...] Read more.
Background and objectives: Involuntary loss of urine owed to dysfunction of the detrusor muscle or muscles of the pelvic floor is known as urinary incontinence (UI). In this study, ultrasound monitoring was employed for the first time to measure the usefulness and safety of electromagnetic stimulation for women with Stress or Urge UI. Materials and Methods: A total of 62 women were enrolled, with a mean age of 55.1 (±14.5); 60% of them were menopausal and presented with urinary incontinence (UI). Eight validated questionnaires were used to evaluate Stress UI, prolapse, overactive bladder urge, faecal incontinence, and quality of life, and the whole study population was tested with ultrasounds at the beginning and at the end of the treatment cycle. The device used was a non-invasive electromagnetic therapeutic system composed of a main unit and an adjustable chair applicator shaped for deep pelvic floor area stimulation. Results: Ultrasound measurements and validated questionnaires revealed a consistent and statistically significant (p < 0.01) improvement of the mean scores when pre- and post-treatment data were considered. Conclusions: Study results showed that the proposed treatment strategy led to a significant improvement in Pelvic Floor Muscle (PFM) tone and strength in patients with UI and pelvic floor disorders, without discomfort or side effects. The demonstration was qualitatively carried out with validated questionnaires and quantitatively with ultrasounds exams. Thus, the “chair” device we used represents valuable and effective support that could be widely employed in the gynaecological field for patients affected by different pathologies. Full article
(This article belongs to the Special Issue Female Stress Urinary Incontinence Treatment: Do We Know Enough?)
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11 pages, 635 KiB  
Article
Efficacy Comparison between Kegel Exercises and Extracorporeal Magnetic Innervation in Treatment of Female Stress Urinary Incontinence: A Randomized Clinical Trial
by Mislav Mikuš, Držislav Kalafatić, Adam Vrbanić, Marina Šprem Goldštajn, Mislav Herman, Marta Živković Njavro, Klara Živković, Goran Marić and Mario Ćorić
Medicina 2022, 58(12), 1863; https://doi.org/10.3390/medicina58121863 - 17 Dec 2022
Cited by 6 | Viewed by 2435
Abstract
Background and Objectives: To estimate the effectiveness of Kegel exercises versus extracorporeal magnetic innervation (EMI) in the treatment of stress urinary incontinence (SUI). Materials and Methods: A parallel group, randomized clinical trial was conducted in the Department of Obstetrics and Gynecology, [...] Read more.
Background and Objectives: To estimate the effectiveness of Kegel exercises versus extracorporeal magnetic innervation (EMI) in the treatment of stress urinary incontinence (SUI). Materials and Methods: A parallel group, randomized clinical trial was conducted in the Department of Obstetrics and Gynecology, Clinical Hospital Centre Zagreb, Croatia. After assessing the inclusion/exclusion criteria, each eligible participant was randomized to one of the two observed groups by flipping a coin: the first group underwent treatment with Kegel exercises for 8 weeks, while the second group underwent EMI during the same time interval. The primary outcome was the effectiveness of treatment as measured by the ICIQ-UI-SF overall score, eight weeks after the commencement of treatment. Results: During the study period, 117 consecutive patients with SUI symptoms were assessed for eligibility. A total of 94 women constituted the study population, randomized into two groups: Group Kegel (N = 48) and Group EMI (N = 46). After 8 weeks of follow-up, intravaginal pressure values in the EMI group were 30.45 cmH2O vs. the Kegel group, whose values were 23.50 cmH2O (p = 0.001). After 3 months of follow-up, the difference was still observed between the groups (p = 0.001). After the end of treatment and 3 months of follow-up, the values of the ICIQ-UI SF and ICIQ-LUTSqol questionnaires in the EMI group were lower than in the Kegel group (p < 0.001). Treatment satisfaction was overall better in the EMI group than in the Kegel group (p < 0.001). Conclusions: Patients treated with EMI had a lower number of incontinence episodes, a better quality of life, and higher overall satisfaction with treatment than patients who performed Kegel exercises. Full article
(This article belongs to the Special Issue Female Stress Urinary Incontinence Treatment: Do We Know Enough?)
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8 pages, 283 KiB  
Article
Surgical Effect Observation and Treatment Strategy Analysis of Pseudo Urgency Syndrome
by Zhenhua Gao, Han Lin, Kunbin Ke, Tingqiang Yao, Quan Zhang, Ling Li, Xingqi Wang and Jihong Shen
Medicina 2022, 58(11), 1506; https://doi.org/10.3390/medicina58111506 - 22 Oct 2022
Viewed by 1425
Abstract
Background and Objectives: pseudo urgency syndrome among patients with mixed incontinence (MUI) causes and the corresponding treatment strategies is explored. Materials and Methods: A total of 40 patients with MUI are treated with transobturator tape (TOT) and/or solifenacin succinate. Further, 30 [...] Read more.
Background and Objectives: pseudo urgency syndrome among patients with mixed incontinence (MUI) causes and the corresponding treatment strategies is explored. Materials and Methods: A total of 40 patients with MUI are treated with transobturator tape (TOT) and/or solifenacin succinate. Further, 30 patients with simple stress urinary incontinence (SUI) that were treated with transobturator tape (TOT) from the period of December 2018 to August 2020 are retrospectively analyzed; then, their clinical characteristics and therapeutic effects were summarized and analyzed. Results: The effective rates of SUI symptoms in MUI and simple SUI groups were 85% and 90%, respectively; further, the difference was noted as not statistically significant (P > 0.05). Among the 40 patients with MUI, 12 patients had unstable bladder contraction, and the other 28 patients showed normal bladder compliance. The treatment effectiveness rates of SUI symptoms in patients with unstable bladder contraction and normal bladder compliance were 83.3% and 85.7%, respectively; further, no significant difference was noted (P > 0.05). However, the effective rates of urge urinary incontinence (UUI) were 50% and 85.7%, respectively, however the difference was noted as statistically significant (P < 0.05). Conclusions: Most of the UUI symptoms in MUI patients may be “pseudo urgency syndrome” caused by the worry about the leakage of urine, rather than a real sense of UUI that is caused by excessive bladder excitement. Direct surgical treatment in patients with MUI can improve the symptoms of urinary incontinence, and the effect is more obvious in patients with urinary frequency who have normal bladder compliance according to urodynamics. Full article
(This article belongs to the Special Issue Female Stress Urinary Incontinence Treatment: Do We Know Enough?)

Review

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13 pages, 928 KiB  
Review
The Role of Gene Expression in Stress Urinary Incontinence: An Integrative Review of Evidence
by Iva Miličić, Mislav Mikuš, Adam Vrbanić and Držislav Kalafatić
Medicina 2023, 59(4), 700; https://doi.org/10.3390/medicina59040700 - 03 Apr 2023
Viewed by 1342
Abstract
Stress urinary incontinence (SUI) is defined as unintentional urine leakage occurring as a consequence of increased intraabdominal pressure due to absent or weak musculus detrusor contractility. It affects postmenopausal women more often than premenopausal and is associated with quality of life (QoL) deterioration. [...] Read more.
Stress urinary incontinence (SUI) is defined as unintentional urine leakage occurring as a consequence of increased intraabdominal pressure due to absent or weak musculus detrusor contractility. It affects postmenopausal women more often than premenopausal and is associated with quality of life (QoL) deterioration. The complex SUI etiology is generally perceived as multifactorial; however, the overall impact of environmental and genetic influences is deficiently understood. In this research report, we have disclosed the upregulation of 15 genes and the downregulation of 2 genes in the genetic etiology of SUI according to the accessible scientific literature. The analytical methods used for the analysis of gene expression in the studies investigated were immunohistochemistry, immunofluorescence staining, PCR, and Western blot. In order to facilitate the interpretation of the results, we have used GeneMania, a potent software which describes genetic expression, co-expression, co-localization, and protein domain similarity. The importance of this review on the genetic pathophysiology of SUI lies in determining susceptibility for targeted genetic therapy, detecting clinical biomarkers, and other possible therapeutic advances. The prevention of SUI with the timely recognition of genetic factors may be important for avoiding invasive operative urogynecological methods. Full article
(This article belongs to the Special Issue Female Stress Urinary Incontinence Treatment: Do We Know Enough?)
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Other

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14 pages, 1384 KiB  
Systematic Review
Evaluation of Possible Side Effects in the Treatment of Urinary Incontinence with Magnetic Stimulation
by Maja Pavčnik, Anja Antić, Adolf Lukanović, Žan Krpan and David Lukanović
Medicina 2023, 59(7), 1286; https://doi.org/10.3390/medicina59071286 - 12 Jul 2023
Cited by 1 | Viewed by 1593
Abstract
Background and Objectives: Magnetic stimulation is a type of conservative treatment of urinary incontinence. Our aim was to evaluate the possible side effects of this method. Materials and Methods: We conducted a systematic literature review. The key search terms were urinary [...] Read more.
Background and Objectives: Magnetic stimulation is a type of conservative treatment of urinary incontinence. Our aim was to evaluate the possible side effects of this method. Materials and Methods: We conducted a systematic literature review. The key search terms were urinary incontinence, magnetic stimulation, and female. All known synonyms were used. Results: 255 titles and abstracts were retrieved, and 28 articles met our inclusion criteria. Out of 28 studies, 15 reported no side effects, five reported side effects, and eight did not report anything. There was no significant difference in the incidence of side effects between the sham and active treatment groups. Conclusions: Side effects of magnetic stimulation in comparison to other active treatments are minimal and transient. Among the conservative UI treatment methods, magnetic stimulation is one of the safest methods for the patient and as such a suitable first step in treating UI. Full article
(This article belongs to the Special Issue Female Stress Urinary Incontinence Treatment: Do We Know Enough?)
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